Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, South Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
J Arthroplasty. 2020 Aug;35(8):2267-2273. doi: 10.1016/j.arth.2020.03.004. Epub 2020 Mar 7.
Dilute povidone-iodine (PI) lavage, a simple disinfection method, could reduce postoperative infection risk. However, there is no clinical consensus regarding its efficacy in total joint arthroplasties (TJAs). This systematic review and meta-analysis evaluated PI lavage's efficacy in preventing infection after TJA.
MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published before November 22, 2019, that compared postoperative infection rates in patients who underwent TJA with or without PI lavage before wound closure. Subgroup analyses were designed to identify the differences in infection site (overall or deep), type of surgery (total hip arthroplasty or total knee arthroplasty), time until diagnosis of infection (3 or 12 months postoperatively), and primary/aseptic revision arthroplasties.
We included 7 studies with 31,213 TJA cases, comprising 8861 patients who received PI lavage and 22,352 who did not. Pooled odds ratio for overall infection rate for the PI and non-PI lavage groups was 0.67 (95% confidence interval, 0.38-1.19, P = .17) and for the deep infection rate was 0.90 (95% confidence interval, 0.27-2.98, P = .86). Subgroup analyses revealed no differences in postoperative infection rates between the PI and non-PI lavage groups in terms of total hip arthroplasty and total knee arthroplasty, diagnosis of infection at 3 and 12 months postoperatively, or primary and aseptic revision arthroplasties.
We detected no differences in the overall postoperative infection rates between the PI and non-PI lavage groups before wound closure in TJA including all studies in the subgroup analyses.
稀释聚维酮碘（PI）冲洗是一种简单的消毒方法，可以降低术后感染风险。然而，在全关节置换术（TJA）中，其疗效尚无临床共识。本系统评价和荟萃分析评估了 PI 冲洗在预防 TJA 后感染的疗效。
系统检索 MEDLINE、Embase 和 Cochrane 图书馆，检索时间截至 2019 年 11 月 22 日，比较了 TJA 患者在关闭切口前接受或不接受 PI 冲洗后术后感染率的研究。设计了亚组分析，以确定感染部位（总体或深部）、手术类型（全髋关节置换术或全膝关节置换术）、感染诊断时间（术后 3 个月或 12 个月）以及初次/无菌性翻修关节置换术之间的差异。
纳入了 7 项研究，共 31213 例 TJA 病例，其中 8861 例患者接受了 PI 冲洗，22352 例患者未接受 PI 冲洗。PI 冲洗组和非 PI 冲洗组的总体感染率的合并优势比为 0.67（95%置信区间，0.38-1.19，P=0.17），深部感染率的合并优势比为 0.90（95%置信区间，0.27-2.98，P=0.86）。亚组分析显示，PI 冲洗组和非 PI 冲洗组在全髋关节置换术和全膝关节置换术、术后 3 个月和 12 个月的感染诊断以及初次和无菌性翻修关节置换术方面，术后感染率无差异。
我们未发现 TJA 中 PI 冲洗组和非 PI 冲洗组在关闭切口前的总体术后感染率存在差异，包括所有亚组分析中的研究。
